Kwashiorkor: Symptoms, Causes, Treatment, Cost, and Side Effects

Also known as “Edematous malnutrition”, this particular disease occurs when there is lack of protein or severe malnutrition in the body. It happens due to sufficient calorie intake, but with insufficient intake of protein. People with this condition suffer from swollen face, feet and belly but have emaciated limbs. This is because severe protein deficiency leads to the accumulation of limbs within the tissues. This makes Kwashiorkor a different condition when compared to other types of malnutrition induced diseases where there is a general lack of calories.

The symptoms of Kwashiorkor include:

• Pot belly or enlarged tummy
• Severe loss of muscle mass
• Serious infections that are long-lasting
• Cracked nails
• Irritation
• Fatigue or tiredness
• Red patches on the skin
• Failure to grow in height
• Hair loss or fading of hair colour

This disease can be extremely dangerous when the person does not get treated for a very long time. The children and infants can get vulnerable to many infections.

Kids that have Kwashiorkor suffer from incredibly low amounts of albumin, causing them to become intravascularly deficient, and hence, antidiuretic hormone (ADH) rises in reaction to hypovolemia, causing edema. Plasma renin reacts vigorously as well, increasing salt retention. These variables all lead to edema.

Low glutathione (antioxidant) levels are also a feature of Kwashiorkor. It is assumed to be due to the impoverished child's elevated levels of oxidant stress. Increased oxidant amounts are frequent during fasting and have even been observed in situations of chronic inflammation. Better nutritional status and sulfur-containing antioxidants would've been one indicator of reversion.

The primary cause for this disease is not eating sufficient protein or some other important vitamins and minerals.

Developing countries that have poor hygiene conditions, limited supply of food and also, lack of education about the importance of giving their children a proper balanced diet, usually see higher numbers of cases for this disease. Usually, this disease attacks the children. But, it can happen to every age group. In the case of developed countries, the cases are very rare. But it sometimes can happen to people if they neglect a long-term illness or don’t have proper knowledge about good nutrition. Kwashiorkor may happen in the places wherein there is lack of food supply and lesser awareness about nutrition.

The condition is mostly prevalent in the following countries:

• Southeast Asia
• Congo
• Central America
• Jamaica
• Puerto Rico
• South Africa
• Uganda

Do’s:

Consuming protein-rich foods in good amounts can be a good way of preventing this disease. Such foods are:

• Eggs
• Beans
• Nuts
• Seeds
• Sea food
• Lean meat

A diet that is rich in carbs, fats that make up to 10% of the total calorie needs and proteins that make up to 15% of the caloric requirement is considered beneficial for the prevention of this condition.

Don'ts

• When a person is suffering from a long term illness, he/she should not take any medicine or pill without consulting an expert or a doctor.
• The protein or calorie intake should not be added all of a sudan, it needs to be built gradually.

Not to overeat these protein-rich foods. Anything extreme can be harmful for the health of an individual. Therefore, having a balanced diet is very important.

It can often be diagnosed based on a child’s appearance physically. Usually it is diagnosed by witnessing a drastic change or health of a person.

To determine if a patient is suffering from Kwashiorkor, the doctor may come to the conclusion by evaluating the patient's appearance and by asking questions about their diet and health. Some diagnostic tests that are also advised are:

• Proper blood test and a urine test can be done to check.
• Checking the proper functioning of the liver and the kidneys.
• Checking the vitamins and mineral level in the body
• Measuring the protein and blood sugar levels

• Other tests that are suggested to diagnose are:
• The growth measurements of the child/person.
• Checking for BMI (Body Mass Index).
• Taking a sample of hair/skin for testing.

There are several ways or indications that say that the person may have this disease. Look out for these symptoms at home:

• Loss of appetite, no willingness to have meals
• Lack of tissues in muscles
• Dehydration- the body seems to be dehydrated and very dry or dull
• Changes in the colour of hair for eg, yellow or orange
• Very tired or irritated
• Sudden swellings in the parts of the body

There are some things that an individual can do at home to manage this:

• Increase calories (energy-dense) and protein intake
• Can be treated with specially formulated milk-based feeds in the early stages
• Also, “Ready to use therapeutic foods” can be very helpful for the person
• Peanut Butter
• Milk Powder
• Vegetable Oil
• Vitamins in the form of food or supplements
• Sugar

These food items can be easily found in almost every household’s kitchen and can be given to the person to improve his or her condition before it gets more fatal or dangerous.

• It is very important for a person to reintroduce food that are rich in protein and carbohydrates.
• In the initial stages, diagnosing it at the right time and taking good care can reduce the chances of making the condition much worse.
• Usually treatments at home or treatments by the doctor only help the children/people to make this disease go away.
• Therefore, either the people should take proper care at home or the best is to consult a doctor and get better treatments to treat the disease. It is always the best option to include an expert in such cases because the risks can keep on increasing without professional care and guidance.

These food items include:

• Eggs
• Lean meat
• Peanut butter
• Beans
• Milk powder
• Sugar
• Seeds
• Sea food

A Kwashiorkor patient must eat healthy and nutritional food items. Saying that, a Kwashiorkor patient should avoid consuming soft drinks, candy, junk food and alcohol, all foods that constitute empty calories. The goal is to eat the right kind of energy dense (carbohydrates) that will provide you with an appropriate amount of calories.

Treatment of this disease depends upon its severity and the condition overall. The electrolyte or fluid imbalances in the body are supposed to be corrected with the help of intravenous fluid. Antibiotics can be taken for the treatment of infections.

Although the primary concern is to increase protein in the diet, sudden increase and that too in big amounts can be very dangerous. Calories are to be slowly increased by adding carbohydrates, fat and sugar to the diet.n

Yes, the person should go for immediate care because, In the later stages of this disease, the chances of intellectual and physical disabilities get extremely high. In some cases, it can lead to death.

Therefore, just when you have realized that you have Kwashiorkor or have been diagnosed with it medically, you must go for immediate care and consult a doctor. As it is said “a stitch in time saves nine”.n

A physician or a normal/general surgeon is usually the one who is initially consulted for this condition. nDue to severe pain in this condition, emergency room admissions are extremely common.

Antibiotics like: chloramphenicol and tetracyclines inhibit protein synthesis by putting a hindrance with the action of messenger or transfer RNA.

Some of the drugs are carried in the circulation manner to plasma proteins. Kwashiorkor plasma having a low albumin content has a lower potential of binding capacity with the drugs.

The risk of toxic effects gets increased when there is higher concentration of the free form of drug. Microsomal enzyme-oxidising sys­tem detoxifies many drugs in the liver. The function might be impaired in PEM.

Kwashiorkor can be managed with the help of antibiotics. This disease is not very complicated in some cases. In the cases where the organ has not been damaged, Kwashiorkor can be treated with the help of medicine and surgery may not be needed. However, where the stomach or other limbs are swollen or are damaged internally, that is when the operation or surgery needs to be done immediately.

Medical research says that about 70%-80% of these cases are solved with the help of antibiotics only. Rest 20%-30% are the conditions wherein the patients do need surgery.

As you all know that all surgeries come with their own complications, but you can minimise them by logging on to Pristyn Care as they are highly experienced and skilled in dealing with such problems.

A small infusion of plasma is very beneficial in the cases where there is severe peripheral circulatory failure and of the whole blood or just the RBCs when there is severe anaemia. Under these conditions, hypoxia damages the myocardium and there may be a risk of acute heart failure. Infusion should be very low and “frusemide” should be given at the start.

Usually the child or the patient does not need any surgery to recover from Kwashiorkor disease. nUsually, Kwashiorkor disease occurs after a bypass surgery in adults. And when the complications start to increase and become severe, there can be a need for surgery.

• This disease can be treated free of cost in the government hospitals.
• In the private clinics/hospitals, the average cost of consultation is ₹1000-₹1500.
• The cost of the whole procedure can range anywhere from ₹10, 000 to ₹60,000-70,000.
• Plus, if the individual needs any extra diet plan considering the condition, the cost may increase or decrease.

The treatment takes approximately 2 to 6 weeks. How quick or how well an individual recovers from this disease depends upon how uncomplicated or how severe the condition is. The children having this disease might never reach their full growth potential. They usually remain shorter than their peers.

Kwashiorkor disease can definitely be treated, but if an individual fails to follow the steps or does not continue taking protein-rich foods after a while, then the condition can get bad again.

He or she might need to visit a doctor again or start the treatment by taking antibiotics or other supplements. Once someone suffers from Kwashiorkor, he or she does not grow fully, there are some kind of disabilities that they face unfortunately, that’s why it is essential to continue a balanced diet and follow all the steps carefully that has been mentioned by the doctor.

It is not necessary that once someone gets treated for this disease there will not be a recurrence. But with proper diet and nutritional supplements, health can be maintained and such cases of malnutrition can be averted to a great extent.

• People, esp. the children are needed to be given animal-rich protein (preferably)
• Food items like soya, bananas, sugar and vitamin mixture are very essential in the process of recovery
• Adequate intake of Vitamin B(12)n
• If the symptoms of Kwashiorkor show up once again, do consult an expert
• Several weeks of special feeding and medical supervision
• They should be fed with dilute milk with added sugar.
• Infants who are extremely ill will improve when they are provided 1 gm. protein per kg body weight daily. A great recovery can be seen with 2 gm and recovery does not get increased or better by giving more than 3.5 gm.

• A change hair colour or the skin colour (e.g. to a rust colour)
• Texture of skin and hair can also change
• Damaged immune system — In the cases of severe and recurring Kwashiorkor
• Diarrhoea
• Edema/swelling in the ankles, belly, and the feet
• Failure to gain ideal weight or grow tall
• Fatigue/Tiredness
• Rashes
• Irritability
• Muscle mass loss
• Shock

Side effects in the early stages of the Kwashiorkor disease commonly include apathy, drowsiness, and some kind of irritation.

nKwashiorkor can be responsible for the complications mentioned below:

• Shock
• Intellectual and physical disability on a permanent basis
• Coma
• Growth and height — The children usually don’t grow normally as compared to other peers. The growth is stunted forever.

The entire prognosis is dependent upon how the condition was diagnosed and how well the treatment got started.

nThe chances of recovery is pretty high when the disease gets diagnosed in the initial days.nWhen there is damage physically or menatally, the chances are that it will stay as a permanent thing.nWhen the disease remains untreated or unaddressed the consequences can be fatal.

nUncomplicated kwashiorkor treated with community-based therapeutic care has a mortality of 5% to 15%. However, for complicated cases with HIV infection, mortality can be as high as 30% during admission and 50% at 1 year.n